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Aside from the occasional aches, pains, and sleeping troubles, my 82-year-old mother is in very good health for her age. But like many other older adults, she takes a medication to help control high blood pressure symptoms. And like plenty of older individuals, she relies on her doctor to let her know whether her current blood pressure readings are appropriate or whether greater effort is needed to bring them down even further.
But the right blood pressure target has been…well, a moving target in recent years. Before we go through the shifting recommendations, here’s a quick primer on high blood pressure.
WHAT YOU SHOULD KNOW
Want to know more about what your blood pressure numbers mean? See our post “Blood Pressure Chart: Where Do Your Numbers Fit?“
Blood pressure is the force of blood against the inside walls of your arteries. High blood pressure (hypertension) is defined as a systolic pressure of 140 mm Hg or higher and a diastolic pressure of 90 mm Hg or higher. The “mm Hg” refers to millimeters of mercury. Systolic is the “top” number in your blood pressure, and diastolic is the “bottom” number. So if your blood pressure is 119/70 mm Hg (good for you, by the way!), your systolic pressure is 119 and your diastolic pressure is 70.
A systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89 is considered prehypertension—a warning stage that you need to take steps to avoid full-blown hypertension. A normal or healthy blood pressure is a systolic pressure of under 120 and a diastolic pressure of under 80.
Seems pretty straightforward, right? Not exactly.
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Reading Into Blood Pressure Symptoms
While the actual definitions of normal, prehypertension, and hypertension are still technically the same, the recommendations for what certain groups of people should aim for are the subjects of some debate.
The American Heart Association (AHA) and the American College of Cardiology (ACC) have recommended for some time that healthy adults under 80 should strive for a blood pressure of less than 140/90. But healthy adults 80 and older have a little more leeway. The AHA and ACC recommend that this older population should get their blood pressure below 150/90.
However, in 2014, a panel of experts drafted a set of recommendations that was published in the Journal of the American Medical Association (JAMA). Among the key suggestions: Healthy adults under 60 should aim for blood pressure of under 140/90, and those older than 60 should try to keep their blood pressure under 150/90.
The JAMA recommendations, as you might imagine, triggered debate. Some experts argued that those higher limits are safe for individuals who are otherwise healthy, and that taking multiple medications to drive down your blood pressure and address blood pressure symptoms can increase the risk of side effects.
One of the biggest risks of aggressively trying to lower a person’s blood pressure is that multiple medications can work too well. A sudden drop in blood pressure can lead to the three F’s: fainting, falls, and fractures.
But other experts say that making 150/90 as a ceiling for high blood pressure in anyone 60 and older is just too high. They believe that this more relaxed target could be a serious health risk for many people. High blood pressure is a leading cause of stroke, heart attack, heart failure, and other serious cardiovascular problems.
The argument for really lowering your blood pressure got a big boost in the fall of 2015 in a study known as SPRINT (Systolic Blood Pressure Intervention Trial). Among the findings of SPRINT were that adults 50 and older had significantly lower rates of a composite of heart attack, heart failure, stroke and death from any cause when they were treated with medications to get their systolic pressure below 120, compared with those just trying to keep their systolic pressure under 140.
Not surprisingly, plenty of doctors spoke out in favor of the SPRINT findings, while others said the risks of pushing blood pressure down below 120 may be worse than the risks of having blood pressure closer to 140.
The Bottom Line on Blood Pressure
So what’s the answer? What should be my mom’s target blood pressure? What should yours be?
Well, if you have diabetes or kidney disease, for example, you should try to keep your blood pressure below 130/80. If you have a history of stroke or heart disease, you should also try to lower your blood pressure if you’re normally in that 150/90 region. If you’re younger than 60 and in good overall health, you should try to get your blood pressure under 120/70.
But if you take multiple medications every day for other health problems, adding additional anti-hypertensive drugs daily to get your blood pressure down a few more mm Hg may lead to drug interactions that put you at greater risk than an elevated blood pressure.
The bottom line is this: Lower blood pressure is better than higher blood pressure. But what’s right for you may not be right for your best friend, even if you’re both the same age. Blood pressure management is an individualized endeavor. It depends on your personal health history, any family history of high blood pressure or cardiovascular disease, your weight, age, diet, the amount of exercise you get, your smoking history, and whether you have conditions such as diabetes or kidney disease.
So talk with your healthcare provider about your risks, as well as what lifestyle changes you can make that can help improve your blood pressure. Try to decrease the sodium in your diet—less than 2,300 mg daily or 1,500 mg if you have established hypertension. Get 30 to 40 minutes of exercise daily. Quit smoking. Manage stress through yoga, breathing exercises, or avoiding stressors in your life. And if you’re overweight, lose weight. Even dropping five to 10 pounds can often make a difference in your blood pressure.
Even with a healthy lifestyle, controlling your blood pressure can often require more than one medication. But as I remind my mother, exercise and a healthy diet can help those medications do their job.
And whatever you do, don’t stop taking your blood pressure-lowering medications once you arrive at your desired target. The reason your numbers are where they should be is because you’re taking your pills and doing all the other things the right way. High blood pressure isn’t like a broken bone that heals and doesn’t need any more attention. It’s a lifelong commitment that requires your best efforts and the best guidance your healthcare provider can offer.
OUR BLOG LOG
Besides authoring informative, straightforward, easy-to-understand posts on a variety of medical issues, conditions, and treatments, our consumer health experts use a personal touch to help inform you via our series of UHN blogs.
- Aging & Independence: “What’s Ailing You? We’re All Ears” by Timothy Cole
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- Cancer: “A Crusade Against Cancerous Moles,” by Jim Black
- Digestive: “Blood Tests, My Liver, and Me,” by Timothy Cole
- Eyes, Ears, Nose, & Throat: “Antibiotics Are Over-Prescribed,” by JoAnn Milivojevic
- Eyes, Ears, Nose, & Throat: “How to Get Through Allergy Season,” by Jay Roland
- Heart Health: “What’s the Right Blood Pressure for You?” by Jay Roland
- Nutrition: “What Is Nutrition?” by Dawn Bialy
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Originally posted in 2016 and regularly updated.